Medicare has four parts, and each one covers different healthcare costs.
Medicare Part C, also called Medicare Advantage, is an alternative to original Medicare. It is an all-in-one bundle that includes medical insurance, hospital insurance, and prescription drug coverage.
Medicare Part D offers only prescription drug coverage.
Below, we examine the differences between Medicare Part B and Part C in terms of coverage and costs. We also look at eligibility and enrollment in each of the two plans.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare Part B is healthcare insurance that covers outpatient care, such as doctors’ visits, along with many screening and preventive services. It also covers durable medical equipment, such as canes, crutches, and blood sugar monitors.
Part B is not a stand-alone insurance plan. As original Medicare comprises Part A and Part B, a person who enrolls in Part B is automatically enrolled in Part A, which covers inpatient hospital care, hospice care, skilled nursing facility care, lab tests, and home health care.
Medicare Part A and Part B do not cover the following:
- prescription drugs
- dental care
- vision care
- hearing care
- routine foot care
- custodial care
Part C, or Medicare Advantage, is an alternative to original Medicare and is offered by private insurance companies.
A person enrolled in Part A and Part B can join a Medicare Advantage plan. In addition to hospital (Part A) and medical (Part B) coverage, most Advantage (Part C) plans also cover:
- prescription drugs
- dental, vision, and hearing care
- additional perks, such as gym memberships
Medicare Advantage offers different benefits through several plan options, which a person can choose from to suit their medical situation.
A comparison of Medicare Part B and Part C shows several differences.
It is helpful to remember that enrollment in Part B also involves enrollment in the accompanying Part A. Therefore, instead of comparing Part B with Part C, it is more accurate to compare the Part A-Part B combination with Part C.
The chart below compares Medicare Part A and Part B (combined) with Part C (Advantage):
|Part A and Part B||Part C (Advantage)|
|Coverage provider||Medicare||private insurance companies|
|Choice of provider||any healthcare provider who accepts Medicare||only in-network providers|
|Out-of-pocket costs||may be higher than Advantage||tend to be lower than Part A and Part B|
|Prescription drugs||must have a Part D plan||some plans include prescription drug coverage|
Costs: Part B and Part C
Original Medicare (Part A and Part B) and Advantage (Part C) plans have different costs.
In 2021, an individual with Part B must pay a standard monthly premium of $148.50 and the yearly deductible of $203. They must also pay 20% of the cost of Medicare-approved services after they have met the deductible.
A person with Plan B also has Plan A, but most people with original Medicare do not pay a Part A monthly premium. However, a $1,484 deductible is payable for Part A hospital inpatient services for each benefit period, together with coinsurance that varies from $0 to $742.
As Part A and Part B do not cover most medications, an individual may wish to purchase Part D, which is prescription drug coverage.
Part C (Medicare Advantage)
Every year, each Medicare plan sets out the amount it will charge for premiums, deductibles, and services. The amount varies among plans, and some plans offer zero premiums.
Also, because a person must have enrolled in Medicare Part A and Part B to qualify for Medicare Advantage, they must pay the Part B monthly premium. Some plans may pay the premium, either in part or in full.
Deductibles and other out-of-pocket costs vary among plans. However, Advantage plans have a maximum out-of-pocket spending limit, which the government sets. After a person reaches their plan’s annual cap, the plan generally pays their covered healthcare expenses.
Eligibility and enrollment Part B vs. Part C
Original Medicare (Part A and Part B) and Advantage (Part C) plans vary in their eligibility and enrollment requirements.
After a person gets Social Security benefits at age 65, Medicare automatically enrolls them in Part A and Part B. If a person meets the age requirement but does not receive Social Security benefits, they will not automatically get Medicare and will need to sign up for it.
If someone does not sign up for Part A and Part B during the Initial Enrollment Period (IEP) when they first become eligible, they may sign up during the general enrollment period, which is from January 1 to March 31 every year.
An individual may apply for Medicare online here.
Part C (Medicare Advantage)
A person who has Medicare Part A and Part B and does not have end stage renal disease is eligible for an Advantage plan. An individual may switch from Part A and Part B to an Advantage plan during the initial enrollment period or the open enrollment period, which is from October 15 to December 7 of every year.
To enroll in an Advantage plan, a person first needs to select a plan in their area. After they decide on a plan, they may request an enrollment form from the insurance company offering it or enroll on the company’s website.
In comparing Medicare Part B with Part C, one of the primary things to keep in mind is that Part B comes with Part A.
Original Medicare comprises Part A, hospital coverage, and Part B, medical coverage. Part C/ Advantage plans are the alternative to original Medicare.
Both original Medicare and Advantage plans have pros and cons. Part A and Part B allow a person to choose any healthcare provider, but the out-of-pocket costs may be higher. Conversely, Advantage plans require an individual to choose from in-network providers, but they may involve lower out-of-pocket costs.
If a person will soon be eligible for Medicare, they may wish to compare the coverage, costs, and other differences between the two options. It is important for an individual to choose the one that best meets their needs.